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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL ,4/tL//n -r,&1)
<br />Certificate of Occu pancy l\I -rv
<br />Ngtes; flemaJkg, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />O14 NF-R BtII LDER DEL('ARATION
<br />I h.G!.- arfm und.r rFEh! ol Fjlry lhal I m crmF from l,E C{drocl.R l.E@ l,$ Lr lhc nnhslu di,n lsd ?011 5
<br />llGi.6s dn Prof*trn ('o<k) Any Ciry or Coulny rn'cn r<uro ! p6'n( lo (,trrtud. rhd. inpft,r. &tulish or !.tbt a)
<br />3ttuduq Fi{ ro nr i{u4., 6ko r.qrir6 rh. rpplaDt (tr $.h Fni' r. fik a sti.n sldMl rh, h. or shc t li(mEj DUNJi
<br />ro rh. FornrcN ofrlE Co.rrrrors l,r.tu d Lif, loErid 9. ( oftnffirns *'ih S..lion 70(x) ofDlvBp, ll ofrh. a6rn6,nd
<br />l'mfdrions ( o&) or th'l rE or .h. ie .r.mfl rhdcGom ed rhc t !s ror rh. ,lh.d .r6prion An! riolri.nof sdi.n 7(r1l 5 bJ 6nt
<br />rpplic.nr for . pamn 3ubjds rh. ?plicor ro 0 cir il F.,ht o f mr mR rhs 6\. h!.r!.d &rlld! I ttol))
<br />L B olE ollh. F.rEly. m,n) hplolG u ilh tras6 6llEr $k comFEnno- trnl dr lt trqtdn[.rdm6m!
<br />da dl orolldal tue].(sc 7044. adin*! Md PNl<\i!N (iil.: IlrCoftr(roi! Li.o* kwdo6ml rprly lo Mosncrof
<br />rh. I'rtEn' tr lF l!il& or i@ro\ 6 tlEsc d $ b .IE uh $..t ninElt or hdvlf or lhreu8fi iB or lE otrn srll,lor6,
<br />Iroviddl rh.r su.h idFovffiB ft frn i ad-l or olrdd aor sL l( hos6q, rlE hillng or itrrF$G6r ts $ll wdh'n on. )sr
<br />of or!)ldiotr rlE ()$ nd tt lld *iN hlk LIE tlrdar orFn rg thi k q:rE{Ldfl{ tx lorihFs\.rlEFF y lor th. ,r4x*of
<br />l, 6 o*M of rlE Fop6rr, m.rclun.L contdinr \ nh li(au.n codtroE ro odM
<br />'lE ,mr6r (S< 7ol.t. t\B'B
<br />!i P$kri'n Co& Th. Cont&l(tr ! l. r.6. l-as do6 d'r oppl, ro e o{u otproFny who b! il& or inprov6 rhdarn,
<br />ed uho o d! fr 3u.t Foj.<r unh. (tdBl."lr lk.{.n plr66
<br />'. llE Coddm . tic@ ls )
<br />I un ctmp{ und( Sarnrn
<br />l).1. oinr
<br />r!alit&5:g)uffi_sr1ra!
<br />DICIAAAIIIII
<br />I h<.hr aflinn unrLr FBlr) of FJo!.rcolrh. aoll(N i4 &.1!rhB
<br />I h!r. ,rj s iU minr.m ! ( difd. of CoM! k, s.la.l Mr. ror h,.k6 .odrFMirn. B F\ iH for b! S.dhn r70o of rh.
<br />llbo. Code fd lh. Ffome. of rh. $ o* aor $n(h rh. Fmi ! e.rl
<br />I h,\..nd $ ill mrinrrn *ork6 comF6.rioo i60ftq s r.nun.d by Sdrion !7m orrh. t:hor G)&. ao. lh. Ff(nfumc of
<br />lh. *ort for vhkh rhis Fmn i! i!u.d. M, $ Nld Nnpdlr.r io. iNrtu.. .oid xrl polk, numb.r r.
<br />l.ciiaythn in rh. Ftoms!. olrhr {orl lor $hih rh! Frrir 6 BU6I I shrll Rn dpLr rn, F*'n in !n, mMnd
<br />$ s lo b..oft sut{frl lo lh. $$ 6'compqsllion h$of ( difomi.. ud 3grlh3l if I shouH bdom subj<t lorrE
<br />r! c comFN'lon Fov6ioB of Sdn lrm or rh. t t$r Co&. 1 !h.ll. fonhr nh onpil r hh rhor pro\ itioB
<br />WARNINC: l:ailur.lo suc wrt6 coaFsdn,n Nw+c n unbwtul. &d shlll lubjct e npkrrr ro rnnin.l tEm!6 dd
<br />.nil nn6 up b oc hu*lEd ihousir! dollrB (tluo.ql(
<br />Sdrio. :1076 of rh. l rbor (_oda intd< &d! orn , s f6
<br />colp.@riotr d.mgd B F lirt d tor tlE
<br />I hscb, ailtnr unds rEmli) or p.,ju, ,- I hd I on ltfl€d und6 lcnnl't6 q (.onnrmcinr *ith ssti,n 70m) ol Dn rnrn r
<br />of rh. BGrna e PFf6o6 (-od.. an mr lk.e 6 i. tull L... in.fid
<br />(/t'ci Oo I
<br />I hdlby rllm ui&r p6.lry of Frury dii rtE a. ordrucrb! bnns .s*y turh.Fflxlrl,aofrlEmrl6r *ti(h lhi! Fnl i!
<br />E!u.d (Sa. lO97. Civ. C ).l,.dd r NM.
<br />affuri.dfDEcuadr.uE
<br />I hdAl.trnn und6 rEnllly ofFJur) oEorrh. tolh*rn8 d.(1 .!ioN
<br />l)cnohion l,6mils.AsbdG Nrlilica!rrn t.daal R+!ldi)tu (l irl.40, Pd6)
<br />R(uircd lnid of No!fi cllsn
<br />I.diryrhal lh. L!(il rcrulDl mns r.s din! asltslos r dno\ al de nnl ipnl'(ahl. r,) lhls fl ojrr
<br />I..r1,li rl' l hr\.rcrLlrh,s lll)fh.rrkrrd{r(cll r Irtr.in).on,Pl)\irhall( [!rnll(otrir!
<br />odtr1m6 r,nl s'd. L*s rldit k, bildins cod &!lr,riz. r.F6ddn6 of fin (-ny xd aou.r) ro ord o|!nrlE
<br />rhr. trtrTrk,k\l pn,lE1' ln' ,nsB\rk)n
<br />tpplk. or tldr tirflIure
<br />hrmnR nrnrc rprinrr' K 'rq h
<br />-,, !,oy'21/z"t 4
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<br />II
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<br />II
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